IntroductionOvertraining. Burnout. Staleness. These are descriptive words used by fitness professionals to describe the phenomenon that sometimes affects fit individuals. Overtraining is a major concern with highly active fitness enthusiasts because it is responsible for decreased or impaired performance and increased fatigue, both during training and daily life. Overtraining syndrome (OTS) usually occurs as result of a training schedule that is dramatically or suddenly increased, lasts for sustained periods of time, and is performed at high volume or high intensity, or both without a sufficient recovery period. Although some personal trainers and highly motivated exercisers may abide by the principles of go hard or go home and constantly giving 110%, it is crucial to realize that a varied training program and regular evaluation is necessary for improvement and prevention of OTS. This article will review OTS, including the physiological, psychological, immunological and nutritional signs and symptoms. Examples of burnout (low workout enthusiasm) are also discussed to help identify such characteristics in conditioned individuals. Most importantly, health and exercise professionals will be informed with contemporary information necessary to prevent, detect, and care for physically active clients suffering from OTS.

What physiological factors are associated with OTS?Before a fitness professional can care for a client with overtraining syndrome, he or she must recognize and understand the physiological factors associated with OTS. Endurance trained individuals who work out for hours at a time have been shown to have an overactive pituitary gland, which, through a series of biochemical reactions, results in abnormally high levels of cortisol secretion, the stress hormone which may impair muscle growth (1). The human reproductive system may be compromised; women sometimes become amenorrheic (abnormal lack of a menstrual cycle) and men may have decreased testosterone levels (2). Johnson and Thiese (2) also note that overuse injuries such as posterior tibialis syndrome, lower limb stress fractures, and tendonitis may occur.

What psychological factors are associated with OTS?Mood changes are an early and sensitive marker of OTS. Emotional disturbances usually occur before a noticeable drop in performance and parallel an increased training load (4). Depression and chronic fatigue represent the most common OTS condition observed in highly fit individuals (5). Research (3, 6, 7) has shown that clinical depression and OTS have numerous symptoms in common (see Table 2), including changes in neurotransmitters, immune responses, and hormones.
Personal trainers should discuss their observations with clients to openly resolve concerns together. Consultation with a sports medicine psychologist or qualified health expert may be necessary if the condition does not seem to improve with time. Fitness professionals should also realize that their clients may also be dealing with stressful conditions involving work, family, school or social environment situations, which may contribute to OTS.

How does the bodys immune system respond to OTS?A tell-tale sign of OTS is immune suppression expressed in increased rates of illness (especially upper respiratory tract infections {URTIs}), swollen lymph glands, flu-like symptoms (body aches, upset stomach), bruising, and slow healing of scratches and wounds (4, 8). Although an individual may already be very fit, the trigger for illness or injury may be a result of the following two factors: 1) a sudden increase in exercise volume (i.e., increased running distance and/or frequency, or increased repetitions x sets in resistance exercise), and/or 2) an abrupt increase in intensity (i.e., elevated heart rate during cardiovascular exercise or increased intensity {higher %1RM} in resistance exercise). This period of immunosuppression is referred to as an open window, because an individual is most susceptible to contracting infections or getting injured immediately after and during times of increased mental and physical stress. According to David C. Nieman (1), the open window is a three to 24-hour time period following prolonged endurance exercise when host defense is decreased and risk of URTI is increased. The bodys immune system functions are directed towards aiding whatever damage is done by the training overload, thus overall immunity is lowered. Studies have shown that physiological changes take place in cells specifically related to immune function during times of increased training stress and volume (6). The open window for increased susceptibility to illness has been observed after high volume and high intensity exercise sessions.

The decreased immune function/OTS connection has also been linked to nutritional deficiencies, as discussed in further detail in the following section. Failing to eat enough healthy sources of protein, carbohydrate, and fat compromises immune function by not allowing the body to repair itself and recover for continued bouts of exercise.

Recreational enthusiasts who enjoy competing in athletic events or are adamant about daily workouts should be aware that a string of illnesses may be linked to OTS. Oftentimes, individuals who are serious about training may attempt to work through an illness, only to prolong symptoms or cause a recurrence, which further delays training at optimum levels. An appointment with a physician is in order for any client who has an especially severe illness, cannot shake a prolonged ailment, or has recurring bouts of poor health.

Does nutrition impact OTS?Many fit individuals who follow a strict workout schedule also adhere to strict dietary regimes. Societal pressures may influence these individuals to limit caloric intake, with the (mistaken) belief that they are maintaining a sleek physique and aiding performance in the gym. However, not sufficiently fueling (and refueling) the body is detrimental to training and recovery, and a contributing factor to OTS.
After a hard workout, intramuscular stores of glycogen are depleted, which makes carbohydrate consumption essential. Consuming foods such as a bowl of corn flakes with raisins, a handful of vegetables (with baby carrots, broccoli, and cauliflower), a fruit salad (with strawberries, bananas and pineapple), or your favorite pasta dish can speedily refill glycogen stores. In fact, consumption of sufficient and healthy sources of carbohydrate, protein and fat are necessary to continually perform at a high level day after day. Nutritional imbalances may result from reduced dietary intake and exaggerated energy expenditure. Overall fatigue and injury often occur when energy expenditure continually exceeds caloric intake and the body is not properly fueled to sustain exercise. Early warning signs include loss of appetite and unnecessary or unwanted weight loss. Recreational enthusiasts should be aware that exercising, even at moderate efforts, stresses the body and results in increased metabolism, additional heat production, and a multitude of physiological and hormonal changes requiring an increased demand for fuel and a balanced diet (9). Consultation with a Registered Dietician with a background in sports nutrition is recommended for clients who need guidance in meal planning and nutritious food choices to sustain an active lifestyle.

When does resistance training lead to overtraining?Resistance training workouts are designed by combining choice of exercise, order of exercise, exercise volume (sets x repetitions), load or intensity (percent repetition maximum), and rest between sets. According to Fry (11), the two most common triggers of OTS in resistance training are workout volume and intensity.
1) Excessive training volume over an extended period of time:
This occurs when an individual adds exercises, performs more exercise sets, and/or increases frequency of workouts. The signs and symptoms that appear, due to this type of overtraining, are similar to those seen in endurance exercise. Fry (10) adds that high training volume often results in a decrease in the ratio between testosterone to cortisol, thus impairing muscular fitness gains.
2) Excessive training intensity:
This occurs when an exerciser uses too much resistance (%1RM) for prolonged periods of time. It may cause increased sympathetic (the accelerating branch of the autonomic nervous system) nervous system activity in order to adjust for decreased muscular strength.
Perhaps one of the best design strategies a personal trainer can incorporate to prevent overtraining in resistance training is to utilize a periodization training program with clients. Periodization is most widely used in resistance program design to avoid over-training, while maximizing performance gains and recovery. Traditional models of periodization describe a progression from high volume and low-intensity (%1RM) work towards decreasing volume and increasing %1RM during the different cycles. A reduction in volume and an increase in intensity in steps during the training cycle is referred to as stepwise periodization. In the overreaching periodization model there is periodic short-term (1-2 week) increase in volume or intensity followed by a return to normal training. During undulating periodization, training volume and intensity are increased and decreased on a regular (weekly) basis, but not in the general pattern of always increasing intensity and decreasing volume as the training period progresses. Periodization training is typically divided up into three types of cycles: microcycle, mesocycle, and macrocycle. The microcycle is generally up to 7 days. The mesocycle may be anywhere from 2 weeks to a few months and can further be classified into preparation, competition, peaking, and transition phases. The macrocycle refers to the overall training period, usually representing a year. For a comprehensive article on periodization and other resistance training design ideas, the reader is referred to the article by Sorace and LaFontaine on Resistance Training Muscle Power: Design Programs that Work (ACSM Health & Fitness Journal, March/April 2005, pp. 6-12)

Wait, what is burnout?Burnout is the term used to describe a lack of motivation or dissatisfaction in an activity that was previously enjoyed (11). Meyer and Whelan (11) note that other symptoms are mental exhaustion, lowered self-esteem, emotional isolation, and increased anxiety. However, the physiological symptoms that accompany burnout are the same seen with OTS. A key application for the personal trainer or fitness professional to help his/her client avoid burnout (and OTS) is to prevent boredom and unreasonable training overload. Workouts should be designed, if possible, around an individuals preferred activities and regularly mixed up to give the exerciser variety. A change in scenery (i.e., outdoors vs. indoors) and day-to-day or week-to-week schedule variation (as utilized in periodization programs) enhances variety and minimizes burnout.

What Every Personal Trainer and Fitness Professional Should Do to Combat OTSPersonal trainers who are aware of the signs and symptoms of OTS have an opportunity to care for and/or prevent the condition in recreational enthusiasts and athletes. Initially, educating clients on the perils of doing too much, too soon, or neglecting to get adequate rest and healthy foods between training bouts (as well as other contributing factors of OTS) is essential (2). Research suggests the following ideas may be helpful in preventing OTS (7):
A. Keep accurate and detailed records of each clients workout. This allows the personal trainer to effectively monitor and adjust training volume and intensity depending on an individuals current training status.
B. Be sure clients know to eat a healthy diet, drink enough fluid to stay hydrated, and get enough sleep for optimum performance every day. Each days habits contribute toward overall health and well-being.
C. Encourage and allow clients to openly communicate about concerns, both physical and mental.
D. Physical training is affected by emotional health. Explain to your clients and students that job stressors, interpersonal relationships, and other environmental stressors may have a harmful effect on physical performance. Maintaining health and wellness in all areas of life will help to prevent OTS.
E. OTS is most successfully treated with rest and/or meaningful changes in the volume and intensity of a clients present exercise program. The rest and decrease in exercise needs to be individualized for each client. For instance, some individuals may just need one or more recovery days added to their weekly program. Other individuals may need a significant drop in exercise volume (number of sessions, exercises, sets and reps) in addition to lower exercise intensities (heart rate in cardiovascular exercise and %1RM in resistance training). Indeed, other clients may need sustained days of rest from all physical activities to recover from OTS.
F. Highly fit individuals sometimes find complete rest a greater source of stress. Personal trainers should initiate alternative activities that keep individuals active, but aid in recovery. Emphasis toward lower intensity physical activities such as walking, stretching, mind-body programs, and balance, core and stability training may be very suitable program options.
G. An appointment with a physician specializing in sports medicine may be the final direction if OTS persists.

Condensed Version and Bottom LineThe ability to identify and possibly prevent overtraining syndrome is key in the course of designing progressive overload training programs. OTS impacts physiological, psychological, immunological and nutritional well-being, and an abundance of signs and symptoms exist for the keen professional observer to identify. If an individual avoids overtraining, he or she is more likely to improve fitness, avoid burnout, and avoid illness or injury that prevents one from working out. The personal trainer and fitness professional has an arsenal of useful information and tips to prevent OTS, a syndrome that is detrimental to a physically active population of exercisers who seek regular physical activity as a way of life.